Surgical instrument



April 4, 1944- J. J. TIBONE ET AL l 2,345,639

SURGICAL INSTRUMENT Filed Aug. 6, 1941 2 Sheets-Sheet l April 4, 1944-J. .1. TIBONE ET AL 2,345,639

SURGICAL INS TRUMENT Filed Aug. 6, 1941 2 Sheets-Sheet 2 INVENTORSf77/W55 .J 775 O/Vz' Patented Apr. 4, 1944 SURGICAL INSTRUIVIENT JamesJ. Tibone, Oceanside, and Otto Stoye, Rockville Centre, N. Y.

Application August 6, 1941, Serial No. 405,588v 15 claims. y(c1.12s-346) This invention relates to a surgical instrument and moreparticularly, the present invention relates to a surgical instrumentespecially adapted for use in circumcision operations wherein theforeskin is spread apart and is rmly held during the severing operationin such a manner that it may be stretched to facilitate the severancethereof and at the same time is tightly clamped so that there will besubstantially no loss of blood resulting from the incision.

In the past, circumcision operations have been almost universallyperformed through the use of surgical scissors. IThe use of the latterordinarily produced a crude finished job and in addition, causedconsiderable bleeding during the operation and a wound which tookconsiderable time to heal.

Of late, circumcision operations have been performed with the help of aclamp comprising a frame having a circular opening therein and amounting member for the foreskin in the shape of a cone the apex ofwhich, is unitary with a stem which is coaxial with the cone. The baseof the cone has a diameter slightly larger than adapted to engage thefree end-portion of the stem to draw the surface of the cone tightlyagainst the periphery of the circular opening. In operation, theforeskin is spread apart, the cone is inserted Within the prepuce basefirst and is pushedonto the glans until the latter l A enters the recessin the base of the cone. The cone, with the foreskin embracing thesurface thereof, is then inserted into the circular opening and theconical surface of the cone, with the foreskin thereoverY is then drawntightly against the periphery of the circular opening to producehemostatis. The actual severing of the foreskin is then performed with asurgical knife and the incision is made at the line of Contact betweenthe conical surface and the periphery of the circular opening.

The diiliculty of maintaining the foreskin on the surface of the coneduring insertion of the mounting member into the circular opening in theframe has been a source of great annoyance it away therefrom with; greatinconvenience to himself and .consequent loss of time. According to thepresent invention, the stem is provided with a holder mechanismwithmeans adapted to grip the foreskin and hold it `firmly onto the surfaceofthe cone. After the latter with the foreskin held over the surfacethereof, is inserted into the circular opening in the'fraine and thesurface of the cone is drawn ltiglfltly against the periphery of thecircular opening. the holder may be moved With respect to the cone inorder to stretch theforeskin and thereby expose the line of incision. y

Also according to the present invention, while the foreskin is beingattached `to the gripping means of theholder, the latter is locked in aposition adjacent the cone; but after the foreskin has been. gripped,thegholder is released from its locked position and may be moved vawayfrom the cone to stretch the foreskin.

In accordance with the present invention, the holder may be convenientlyand completely detached from the instrument to permit cleaning,sterilization and examination of the partsof the instrument thusinsuring against possible infection of the wound caused by severing theprepuce. The instrument is comparatively simple. and inexpensive tomanufacture, easy and convenient to operate, and durable, in service.The Hease and efficiency of operation should reduce the labor and lossof time of the surgeon performing the4 operation and shorten the periodof Vinconvenience to the patient.

The preferred embodiment of the invention is shown in the accompanyingdrawings and will be hereinafter described in detail. However, it is tobe understood that the invention is not limited to the preciseconstruction and arrangement shown, .as modifications and changes. arecontemplated and such must be considered to be included within the scopeof the claims.

In the drawings: I l

Fig. l is a view of the assembled mounting member and holder of thesurgical instrument with the foreskin-gripping means of the holder inopen position.

Fig. 2 is a view of the complete surgical instrument with theVforeskin-gripping means in closed and operating position. l

Fig. 3 represents an enlarged vertical section view of the surgicalinstrument as shown in Fig. 2, but with the holder moved to a positionadjacent the cone element of the mounting member.

Fig. 4 is a horizontal section 'view taken on line 4--4 of Fig. 3, butwith the gripping means of the holder in open position.

Fig. 5 is a vertical section view of theassembled mounting member and aportion of the holder of the surgical instrument.

Fig. 6 is a partial horizontal section View of the surgical instrumenttaken on line 6-5 of Fig. 3.

Fig. 7 is a view showing a jawof the foreskingripping means inperspective.

Fig. 8 is a view showing the mounting member of the surgical instrument.

Fig. 9 is a View showing an element of the hold:

er mechanism. l

Fig. 10 is a View showing another element of the holder mechanism.

Fig 11 is a view showing still anotherelement" of the holder mechanism.l g 1 'e Preferably and as shown in the drawings,Y the -surgicalinstrument comprises a channel-like' frame I having a Pair of circular,coaxially positioned openings 2l and 3 in its flanges. The opening 3ycarrig-:gs a. thumb-nut 4 rotatably but undetachablymounted therein .bymeans of acollar extending therethrough which is provided with aradially extending annular flange Sengaging the surface of the flange.The thumb-nut 4 is adapt.- ed tol engage the threaded portion 6 of astern I .o f a mounting -memiber which is of suicient length to bridge.the distance between the two flanges .of the frame. To separate theforeskin. the stem I is unitary with the apexof a cone ,8 which iscoaxial withthe .stem l. The base of the `cone 13 is provided with arecess. .9 substantially Yof the sameshape and size of the glans penisofthe patientgto be circumcised, whereby, when the ,coneI 81's insertedinto the prepllce, the recess!! encompasses the glans and the foreskinembraces the Surfaceof the cone .V

The base of the cone lha's la diameter which is slightly larger. than4the diameter of the circular ,opening 2..' Thus, by turning the.thumbnut 4. the surface of the .cone 8 maybe drawn tightly, against ytheperiphery. of the circular opening 2.

In order to holdthe foreskin onto thev surface of the cone 8, the stem'lof the mounting member is provided .with a holder mechanism whichincludes va sleeve, I2slida1bly mounted about the stem I to move towardand away from the cone 8. The extremity of the sleeve, I2 nearest thecone 8, is unitary with ythe apex of a hollow cone II which is coaxialwithltheY Sleeve` I2 and is of such shape and sizethat when the sleeveI2 is moved against the surface of the ,cone B, it will embrace aportion ofthe surface ofthe cone, 8. The sleeve I2 is provided with aplurality of jaws II) adapted tol cooperate with the surface of thehollow @one vI Ir to grip the foreslfrin.v The jaws I0 are hingedlymounted by mec-Ils of Vpins l5 in recesses I3 in ar collar I4 on thesleeve I2, whereby each jaw may oscillate toward and away from thesurface of the hollow cone II. Ordinarily, the business ends of the jawsare urged away from the conical surface I I by the effort-of'springs I6mounted between the forked hinge-portions of each jaw.

To maintain the.1business ends of the jaws I0 against the surface of thehollow cone II, the holder mechanismgincludes 'another sleeve I'I,ceaxially mounted about the jaw-carrying sleeve I2 and adapted to slidethereon.` The sleeve Il is adapted to embrace ythe jaws Ill when movedtoward the hollow cone II to Yswing the jaws to- Ward. the Surface of.the hollow. cone II` against the eifort of the springs IE5. The jaws maybe locked in gripping position by means of a thumbnut I8 adapted toengage the edge of the sleeve I'I and the screw-threaded portion I9 ofthe sleeve I2, whereby, rotation of the thumb-nut i8 controls the extentto which the jaws Il are embraced by the sleeve Il. Thus, the sleeve I'Imay be considered a locking sleeve for the jaws.

In operation, the cone 8 with the hollow cone II covering a portion ofits surface, is inserted into the prepuce so that the foreskin vextendsto and. embraces the surface of the hollow cone II; the sleeve I'I isthen moved toward the hollow cone Il to swing the business ends of thejaws I0 against the surface of the hollow cone as describedhereinbefore, to hold the foreskin firmly V face of the hollow cone I Iafter the cone S is in- Ano serted. into the prepuce, it is desirablethat the `liollow cone Il remain adjacent the cone 8 during the grippingoperation. With this object in view, a leg of the forked hinge-portionof one of the jaws is unitary with a cam 2i), shown in detail in Fig.'7. The cam 2S is adapted to enter into and to be engaged by a recess 2land a track 22 which is continuous with the recess 2I, in the steml ofthe mounting member. The cam 20 is so designed that it is capable ofcooperating with the motion of the jaw with which it is unitary and b ywhich Yit is actuated; whereby, the earn engages the recess 2l while thebusiness end of the jaw with which it is unitary, is in any positionbetween the gripping position and that which is perpendicular thereto,but when the jaw is in gripping position, the cam 2E! can only engagethe track 22, as shown in Figs. 5 and 3, respectively. This arrangementpermits the sleeve I2 to slide away from the cone when the jaws are ingripping position and at the same time, prevents the sleeve I2 fromsliding oif the stem l of the mounting member during operativemanipulations. This is a most desirable feature of the invention as itmakes it possi-ble to stretch the foreskin, after mounting, prior to theactual severance thereof.

' VIn order that the sleeve I2 may be completely and convenientlydetached from the mounting member for cleaning and sterilization of theparts, the cam 2i] is so designed, that when jaw with which it isunitary, is swung to substantially the extreme end of its arc of travelaway from the surface of the hollow cone Il, it will not engage orproject into the track 22. This may be accomplished Vby removing thethumbnut IS to release the sleeve Il, sliding the latter away from theconical surface II until it no longer engages the jaws Il), and finally,swinging the jaw which is unitary with the cam to the extreme end of itsarc of travel away from the surface of the hollow cone II.

To avoid rotation of the mounting member when'the surface of the cone 3is being drawn against the periphery of the circular opening 2, thesleeve Il is provided with an elongated projection or key 23 projectingfrom the interior surface of the sleeve I'I and adapted to slidablyengage a slot 24 in the collar I4. In operation, when the jaws III arein gripping position and the cone 8 is being drawn against the peripheryof the circular opening 2, the locking sleeve I'I is held firmly by theoperator. Thus, the key 23 and the slot 2li cooperate to prevent thejawcarrying sleeve I2 from rotating. and the cam 20 and the track 22 orrecess 2l in turn, cooperate inbefore.

2,345,639 'toprevent the mounting member from rotating.

In practice, the operation of the instrument is as follows: Assumingthat the instrument is assembled as shown in Fig. 2, the mounting memberwith the holder thereon is separated from the frame I of the instrument.The jaw-carrying sleeve I2 is then moved toward the cone S as far as itwill travel and the thumb-nut I8 is rotated to release the lockingsleeve I1 thereby permitting the jaw`s I to swing away from the surfaceof the hollow cone II. This will lock the `surface of the hollow cone IIin a position on the stem 'I adjacent the cone 8 as explained here- Thecone 8 with the hollow cone II embracing a portion of the surfacethereof, is then inserted into the prepuce and is pressed against theglans until the recess 9 substantially completely encompasses the glanspenis of the patient to be circumcised. The foreskin is then in aposition embracing the portion of the surface of the cone 8 not coveredby the hollow cone II and the surface of the hollow cone II. The lockingsleeve I1 is then moved toward the cone 8 to swing the jaws I0 towardthe surface of the hollow cone II cooperating therewith to grip theforeskin. The thumb-nut I8 is then rotated to hold the sleeve IT inlocking position. The mounting member thus attached to the penis, isthen inserted through the circular opening 2 so that the screw-threadedextremity Ii engages the thread ofthe thumb-nut 4. The locking sleeve I1is then held firmly by the lingers of the operator while the thumb-nut 4is rotated to draw the surface of the cone 8 tightly againsttheperipherycf the circular opening 2, to crush the foreskin therebetweento cause hemostatis. The

'holder is then moved away from the cone 8 to stretch the foreskinthereby exposing the line of incision which is at the line of contactbetween the surface of thecone 8 and the periphery of the circularopening 2. The tissue may then be severed at the line of incision with asurgical knife. The thumb-nut 4 is then rotated to release the mountingmember, thereby detaching vthe instrument from the penis.

Although the present invention has been described in conjunction withpreferred embodiments, it is to be understood that modications andvariations may be resorted to without departing from the spirit andscope of the invention, as those skilled in the art will readilyunderstand. Such variations and modifications are considered to bewithin the purview and scope of the appended claims. l

l We claim:

1. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mounting`member for the tissue to be severed extending member.

2. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, and a holder mounted on said mounting member and adapted tocooperate with it to maintain the tissue to be severed on the mountingmember, said holder including a sleeve slidably mounted about saidmounting member to reciprocate thereon, a plurality of jaws hinged tosaid sleeve to cooperate with the surface thereof to grip the tissue tobe severed, and means to maintain the plurality of jaws in grippingposition.

3. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, and a holder mounted on said mounting member and adapted tocooperate therewith to maintain the tissue to be severed on the mountingmember, said holder including a sleeve slidably mounted about saidmounting member to reciprocate thereon, a plurality of jaws hinged tosaid sleeve to cooperate with the surface thereof to grip the tissue tobe severed, springs urging said jaws to swing away from the surface ofsaid sleeve, a second sleeve mounted about said jaw-carrying sleeve toreciprocate thereon adapted to embrace said jaws to swing the sametoward the gripping position against the effort of the springs, andmeans to lock said second sleeve against movement when the jaws are ingripping position.

4. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having a circular opening therein, amember for mounting the tissue to be severed extending through saidopening including a stem and a cone element the apex of which is unitaryand coaxial with said stem, said cone `having a base the diameter ofwhich is slightly larger than the diameter of said circular opening,`means adapted to engage said stem to draw the surface of said coneelement tightly against theperipliw ery of the circular opening toproduce hemostatis at the line of severance, and a holder adapted tocooperate with said mounting member to maintain the tissue to be severedon the surfaceof the cone element, said holder comprising a 'sleeve's1idably mounted about said mounting member to reciprocate thereon, aplurality of jaws hinged to said sleeve to cooperate with the surfacethereof t0 grip the tissue to be severed, and means adapted to limit theamplitude of reciprocation of 'the` jaw-carrying sleeve on the stem ofthe mounting member, to lock the jaw-carrying sleeve Vin a positionadjacent the cone element of the mounting member when the jaws are notin a gripping position, and to prevent rotation ofthe sleeve about thestem of the mounting member.

5. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having a circular opening therein, amember for mounting the tissue to be severed extending through saidcircular opening including astem and a cone element the apex of whichisl unitary and coaxial with said stern, said cone hav- .ing a base thediameter of which' is slightly larger than the diameter of the circularopening in the frame, means adaptedto engage said stem to draw thesurface of said cone element tightly against the periphery of -thecircular openingto produce hemostatis at the line of severance, and aholder adapted to cooperate with said mounting member to maintain thetissue to be severed on tlle Surface of tbecoriey element of themounting member; said holder comprising asleeve slidably mounted aboutthestem of said mounting member ,to reciprocate. thereon, a plurality ofjaws hinged to said sleeve to -cooperate with the surface .thereof togrip the tissue to be severed, a cam unitary with one of said jaws andoperable by theswing thereof adapted to engage a recess in the stem ofthe mounting member when the hinged -jaws are not in gripping positionto lock y a memberfor mounting the tissue to be severed extendingthrough said opening including a stem and a cone element the apex ofwhich is unitary and coaxialwith said stem, said cone having a base thediameter of which is slightly larger than the diameter ofA said circularopening, means adapted -to engage said stem to draw the surface of saidvcone element tightly against the peripheryV of .the circular opening toproduce hemostatis at the line of severance, and a holder adapted tocooperate with said mounting member to maintainthe tissue -to be severedon the surface of the cone element, rsaid holder comprising a sleeveslidablymounted about said mounting member to reciprocate thereon, aplurality of jaws hinged to said sleeve to cooperate with thesurfacethereof to grip the tissue to be severed, means adapted l to limit theamplitude of reciprocation of the sleeve on the stem of the mountingmember, means to lock the jaw-carrying sleeve in a positionadjacentthecone element of the mounting member when the jaws are not in grippingposition, and means to prevent rotation of rthe sleeve about the stem ofthe mounting member.

'7. A surgical instrument for use in operations involving theseveranceof tissue which comprises a framehaving a circular openingtherein, a member for mounting the tissue to :be severed extendingthrough said circular opening including a stem'and a cone element theapex of which-is unitary and coaxial with said stem, said cone having abase thediameter of which is slightly largerfthan the diameter of thecircular opening in the frame, means adapted to engage said stem to drawthe surface of the cone element tightly against the periphery of thecircular opening to produce hemostatis at the line of severance,` and aholder adapted to cooperate with said mounting member to maintain thetissue to be severed on the surface of the cone element of the mountingmember, said holder comprising a sleeve slidablyl mounted about the stemof the mounting member to reciprocate thereon, a collar unitary with theexterior surface of said. sleeve, a plurality of jaws hinged to saidcollar to cooperate with the surface of said sleeve to grip the tissueto be severed, springs urging said jaws-to swing away from the surfaceof the sleeve, a

'locking sleeve mounted about said jaw-carrying sleeve to reciprocatethereon adapted to embrace said jaws to swing the same toward grippingposition against the effort or' the springs, means pro.- jecting fromthe interior surface ofY the locking sleeve adapted to slidably engage aslot in said collar` to prevent rotation of the locking sleeveabouti-,he jaw-carrying sleeve, a cam unitary with one of said hingedjaws and operable by .the swing thereof adapted to engage a recess inthe stem of the mounting member when the jaws are not in grippingposition to lock the jaw-carrying sleeve in a position adjacent the coneelement of the mounting member and adapted to engage a slot in the stemcontinuous with said recess when the jaws are in gripping position tolimit the amplitude rof reciprocation of the jaw-carrying sleeve on thestem of the mounting member and to prevent rotation of the sleeve aboutthe stem, whereby, holding the locking sleeve against rotation willprevent rotation of the mounting member. Y

8. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, and a holder mounted on said mounting member and adapted tocooperate therewith to maintain the tissue to be severed on the mountingmember, said holder including a sleeve mounted about said mountingvmember, and means operatively mounted onto said sleeve to cooperatewiththe surface of the sleeve to hold the tissue to be severed onto themounting member.

9. A surgical instrument for use in operations involving the severanceof tissue, which comprises airame having an opening therein, a mountingmember for the tissue to .be severed extending through said opening andadapted to cooperate therewith to ,produce hemostatis at the line ofseverance, and a holder mounted on said mounting member and adapted tocooperate with it to maintain the tissue to be severed on the mountingmember, said holder including a sleeve and a plurality of jaws hinged tosaid sleeve to cooperate with the surface thereof to grip the tissue tobe severed.

l0. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, and a holder mounted on said mounting member and adapted toccoperatewith it to maintain the tissue to be severed on the mountingmember, said holder including a sleeve, a plurality of jaws hinged tosaid sleeve to cooperate with surface thereof to grip the tissue to besevered, andmeans to maintain the plurality of jaws in grippingposition.

1l. A surgical instrument for use in operations i involving theseverance of tissue, which com prises a frame having an opening therein,a

mounting member for the tissue to be severed' extending through saidopening and adapted to cooperate therewith to produce hemostatis at theline of severance, holding means to maintain the tissue to be severed onthe mounting member, said holding means including a plurality of jawshingedly mounted about said mounting member and adapted to Cooperatetherewith to grip the tissue to be severed, and springs urging said jawsaway from gripping position, and means adapted to urge said jaws towardthe gripping position against the effort of the springs.

12. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, holding means to maintain the tissue to be severed on themounting member, said .holding means including a plurality of jawshingedly mounted about said mounting member and adapted to cooperatetherewith to grip the tissue 'to be severed, and springs urging saidjaws away from gripping position, means adapted to urge said jaws towardthe gripping position, and locking means to lock the jaws in grippingposition.

13. A surgical instrument for use in hemostatically severing theforeskin of the penis, which comprises in combination, a member havingan opening therein adapted to engage the foreskin of said penis, amounting member for said foreskin having a glans receiving recessextending through said opening, means connecting said members for movingsaid foreskin mounting member longitudinally of said penis toward theopening of the other member for exerting a radial pressure with respectto said penis upon the foreskin thereby producing hemostatis at the lineof severance, and a holder mounted on said mounting member and adaptedto cooperate therewith to maintain said foreskin onto the mountingmember, said holder including a sleeve, a plurality of jaws hinged tosaid sleeve to cooperate with the surface thereof to grip the foreskin,springs urging said jaws to swing away from the surface of said sleeve,means adapted to swing said jaws toward gripping position against theeffort of the springs, and locking means to lock said jaws in grippingposition.

14. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, holding means to maintain the tissue to be severed on themounting member, said holding means including gripping means operativelymounted about said mounting member and adapte to cooperate therewith togrip the tissue to be severed, and means to lock the gripping means ingripping position, said locking means comprising a sleeve reciprocableabo-ut said gripping means and adapted to embrace the same when they arein gripping position, and means to lock said sleeve againstreciprocation when said gripping means are in gripping position.

15. A surgical instrument for use in operations involving the severanceof tissue, which comprises a frame having an opening therein, a mountingmember for the tissue to be severed extending through said opening andadapted to cooperate therewith to produce hemostatis at the line ofseverance, holding means to maintain the tissue to be severed on themounting member, said holding means including a plurality of jawshingedly mounted about said mounting member and adapted to cooperatetherewith to grip the tissue to be severed, and means to lock theplurality of jaws in gripping position, said locking means comprising amember reciprocable about said plurality of jaws and adapted to urge thesame toward gripping position, and means to lock said reciprocablemember against reciprocation when said plurality of jaws are in grippingposition.

JAMES J. TIBONE. OTTO STOYE.

